Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 3521 | IL |
NPI | 1326211194 |
---|---|
Provider Name | Steve Rogne |
First Address | Chicago, IL 60645-2469 |
Second Address | Chicago, IL 60645-2469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2008 |
Last Update Date | 11/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3521 | AOBTA (01) | IL |